Journey to Neuro Recovery

Kentfield Hospital’s neuro program is innovative and unique, affording
patients with neurological injury, transitioning from neuro intensive
care units, the best possible chance of recovery. This transitional period
is a time in recovery at which the patient remains with complex neurological
and medical problems that require expert medical knowledge in order to
provide for optimal outcomes. Our team of medical experts is specially
trained and credentialed to care for complex neuro injuries as well as
supporting the patient’s families adjusting to the effects of the
brain injury.

Why Kentfield Hospital?

Kentfield Hospital provides a unique program that targets care for brain-injured
patients in the acute transitional period of their recovery. Kentfield
Hospital benefits those patients who remain very sick and complicated
medically and requires a high level of support, medical expertise, and
attention from a team with expertise in neurocritical care, as well as
general medical care. Kentfield Hospital is currently the only hospital
in the community to provide this unique service.

Kentfield Hospital’s role is to:

Ensure a continuum of neurological, neurosurgical, and medical care throughout
the stages after an acute brain injury.

Ensure that goals of care are constantly addressed and good communication
is provided through the patient’s stay

Intensive Rehabilitation for neuro patients to get them ready for Acute
Rehabilitation or Home

Concierge services for helping patients spend quality time when family/friends
not able to visit

Programs and Services

Inpatient Services

Long term acute care (LTAC) is a specialty hospital for patients who require
medical services coupled with rehabilitation for an extended period of
time to recover and strengthen. At Kentfield Hospital, we offer LTAC services
that are innovative, personalized, and cost-effective. Our knowledgeable
and dedicated medical professionals work around the clock to ensure all
our patients get the high-quality healthcare services they need and deserve.
Using our state-of-the-art equipment and facilities, we have helped countless
patients efficiently recover from their conditions and get back to living
their lives.

At Kentfield Hospital, we work day and night to ensure each and every one
of our patients are provided the care and attention that is owed to them.
You will never have to question if you are getting sufficient medical
care because we will be with you every step of the way throughout the
healing process. Our comprehensive and individualized treatment plans
are custom designed for each patient to utilize the patient’s strengths
to assist with their weaknesses.

Our medical personnel strive to build a relationship with patients on an
individual level and we are well known for our compassionate method of
care. As we build a better understanding of each individual and their
medical condition, we utilize that relationship to more effectively help
the patient and their family.

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Advanced Testing Capabilities

EEG and Continuous EEG

Kentfield’s Journey to Brain recovery program has the ability to
perform regular electroencephalograms (EEGs) and the unique ability to
perform continuous long-term EEGs for up to 24hrs. For the brain-injured
patient having this capability can be immensely helpful for treatment
planning. Our patients are frequently emerging from comas and the clinical
exam does not give a full picture of what is going on in the brain.

The EEGs provide more information that is often critical in treatment decisions.
Seizures, both with overt manifestations, or what is called subclinical
seizures (seizures with no over clinical signs), are fairly common after
any type of brain injury. The EEGs allow us to differentiate these movements
as either epileptic of not thereby direct appropriate therapy. These seizures,
or signs of a propensity towards seizures, may be intermittent, and therefore
monitoring brain waves for a longer time period increases the opportunity
of picking up these abnormalities. Lastly, these brain wave studies in
certain patients may help with prognostication.

Many patients come to the program on multiple sedatives and anti-epileptic
medications that were necessary during their initial ICU treatment but
could now be hindering recovery. If possible, these medications are reviewed
with the goal of minimizing as many of these medications in order to help
wake patients up and help the brain heal. Our EEG capabilities can help
make the process of titrating of these medications safely.

Medication Management and Medication Trials

Recovery from any type of brain injury is a dynamic process. Medications
that may have helped at the beginning of an injury may no longer beneficial
or potentially harmful. On the other hand, new medications may be required
to treat new emerging neurologic problems. There are also certain medications
which may help wake patient up quicker or help with behavioral or cognitive
issues that may develop. Our specialized brain injury team has unique
training and experience in managing these complex medications.

Kentfield’s Role in the Stages of Recovery

Kentfield Hospital serves patients faced with critical illness by providing
unique programs aimed at optimizing recovery. Our ‘Journey to Neuro
Recovery’ Program is designed to serve patients who have gone through
severe neurological injury and need close monitoring from a specialized
neuro team. This program acts as a bridge between acute intensive care
after the initial brain injury and the period of increased medical stability
and convalescence.

This transitional period is a time point at which brain-injured patients
remain severely ill with complex neurological and medical problems that
require expert medical knowledge to manage their neurologic and medical
problems in order to provide for an optimal outcome.

Clinical Leaders

Brain Injury Team

The complexity of brain injuries demands an expert team that is able to
appropriately manage the diagnosis and treat a myriad of brain injuries
especially during the time the body starts to heal itself. Kentfield Hospital
has developed a team of practitioners to manage brain-injured patients.
The team consists of Neuro Intensivists, an acute Neuro Nurse Practitioner,
Hospitalist, nurses, and the ancillary therapy staff.

David Palestrant, MD is Board Certified in Neurocritical Care, Vascular
Neurology, Critical Medicine, and Neurology. He went to medical school
at the University of Arizona. He was an intern at New York Presbyterian
Hospital - Columbia Campus. Dr. Palestrant completed his internal medicine
and neurology residency at the University of Arizona. His critical care
and neurocritical care/stroke fellowship occurred at UCSF.

He has spent his career taking care of patients with severe brain injuries
and is a leader in the development of programs to support patients transitioning
from neuro intensive care units. The goal of these hospital-based programs
is to provide the support and medical expertise needed to ensure patients
transitioning from the neuro ICU have the best chance for maximal recovery.

Hospitalists

Hospital medicine is a type of practice within internal medicine in which
the clinical focus is caring for hospitalized patients. Internists practicing
hospital medicine are frequently called “hospitalists.” An
important aspect of hospital medicine is the ability to collaborate and
communicate with other physicians providing longitudinal care to ensure
continuity between inpatient and ambulatory settings.

Aida Calvillo, MD is Board Certified in Internal Medicine. Dr. Calvillo
graduated from the University Of Washington School Of Medicine in 1996.
She completed her residency at Cambridge Hospital in Massachusetts. Dr.
Calvillo has worked with patients at Kentfield Hospital for over 13 years
including dedicating her practice to neurological patients for the past 5 years.

Nurse Practitioner

Update with the new NP’s info

A neurosurgical NP's primary tasks are to diagnose, treat, and manage patients
with neurological and neurosurgical conditions. Neuroscience nursing encompasses
the entire nervous system, and neurosurgery can include brain surgery,
spinal surgery, and neurological trauma.

Family Involvement

One critical component to recovery is having the help and support of family,
friends, caregivers, or an extended support system. The Case Management
team will schedule an initial care conference as well as continued “family
meetings” throughout the patient’s stay in order to educate,
update, clarify, and coordinate care.

Through the course of the stay, efforts are made to provide for a smooth
transition to living independently. This may include establishing resources
within the community such as transportation, housing, follow up appointments
for prescheduled medical needs, etc. As the discharge approaches, the
interdisciplinary team will involve the family as much as possible to
ensure that a safe, cohesive, and appropriate discharge plan is in place.

Outcomes

Upon 72 hours of admission, our Concierge and Leadership visits the patient
to ensure that expectation has been met regarding satisfaction with the
physicians and licensed staff. If there is any concerns that need to be
addressed after 72 hours, the Director of Quality Management is available
to work together with you regarding your concerns.

Kentfield Hospital measures healthcare outcomes, which include the patient
experience of care, clinical outcomes, and organizational structure that
are associated with the ability to provide high-quality health care. This
data is submitted to the Center of Medicare and Medicaid Services- https://www.medicare.gov/longtermcarehospitalcompare/.

HCAHPS (the Hospital Consumer Assessment of Healthcare Providers and Systems)
is a patient satisfaction survey required by the Centers for Medicare
and Medicaid Services (CMS) for all hospitals in the United States. These
surveys are provided to the patients prior to their discharge from the hospital.

Success Stories

<Kyle to enter success stories, videos and written word, provided by Liz>

Prognostication

Immediately after a brain injury, long term prognosis may difficult to
determine. Time, rate, and degree of progress are variables that can help
solidify a prognosis. At Kentfield Hospital we have a team with expertise
with brain injury, providing a second look at diagnosis, providing expert
knowledge in brain function and recovery, and a team that can follow a
patient through their time at Kentfield Hospital. This allows us to offer
a clearer picture in terms of longer-term prognosis after brain injury.
Most often, brain function and behavior change as the healing process
continues. While the body is going through the process, our team looks
for opportunities to increase success and minimize regression.

Neurophysiology Diagnostics

Evoked Responses

Evoked potential tests are often used to confirm a diagnosis or monitor
the nervous system, rather than determining the cause of an abnormality.
One example is Electromyography (EMG. An EMG is an electrodiagnostic medicine
technique for evaluating and recording the electrical activity produced
by skeletal muscles. Electromyography (EMG) is an electrodiagnostic medicine
technique for evaluating and recording the electrical activity produced
by skeletal muscles.

Free to Breath Program

Kentfield Hospital’s ventilator weaning program is unique and unparalleled.
Our neurodiagnostic approach includes electrodiagnostic computer studies
to assess for phrenic nerve dysfunction and generalized nerve and muscle
injury, which can often interfere with recovery and prolong ventilator
dependence. It incorporates neurodiagnostic techniques, fluoroscopic imaging,
spirometric studies, as well as interdisciplinary clinical evaluations.
Clinical experts providing evaluations may include pulmonology, internal
medicine, and physical medicine physicians as well as respiratory, physical,
and speech therapists to evaluate the mechanics of respiration and prognosticate
the patient’s ability to breathe independently of the ventilator.

This unique, structured approach is not available in any other hospital
system. We started the Free to Breathe Ventilator Weaning Program at a
Kentfield Hospital in 2011 and have been surprised at the amount of neurologic-based
pathology, some previously undiagnosed, which contributed to the delay
in weaning. Diagnoses responsible for respiratory failure have included
Guillain-Barré Syndrome, critical illness neuropathy, cervical
myelopathy/spinal cord injury, phrenic nerve dysfunction, and chronic
aspiration.

By fully evaluating the pulmonary, neurologic, and muscle mechanics of
respiration, our dedicated clinical team can work on specific remediation
strategies to give our patients the highest chance of successfully coming
off and staying off the ventilator.

Predict ventilator weaning potential as it applies to the length of stay,
disposition, and prognosis

Provide feedback to the patient, family and treatment team, payors, regarding
chances of successful weaning

Identification of those patients with a strong potential for weaning successfully

<Kyle to enter Free to Breath video here>

Access to Subspecialties

Telemedicine Program

Telemedicine services are available to enhance the care provided to our
patients. The telemedicine service allows for timely access to physicians
in addition to other specialists who may not be available for an on-site
consultation. The telemedicine physician provides the remote diagnosis
and treatment of patients by means of telecommunications technology. This
service is provided during the hours of 7 pm to 7 am, seven days a week.

Dedicated Staff

Neuro-trained Nurses

The Kentfield Hospital nursing team has received advanced critical care
training as well as continuous advanced instruction covering basic neurophysiology,
neuroanatomy, neuro assessment, and emergency neuro resuscitation. With
over 80 hours of additional neurological training, the nursing staff is
capable of responding to the unique needs of patients who have a neurological disorder.

Because neurological problems can make some patients act erratically, neuro
trained nurses have been provided additional training in the care of such
behavior. As a neuroscience nurse, you must have patience and extremely
effective communication skills.

Respiratory Care Team

The Kentfield Respiratory Therapy Department is passionate about weaning.
When patients arrive at our facility, we immediately begin testing lung
mechanics and the muscles that support respiration. Our neuro-diagnostic
program tests diaphragmatic function using fluoroscopy and EMG testing.
This gives us a map of the patient's capability at admission and allows
us to develop a plan for rehabilitation. The goal is to wean every patient
from ventilator support and return the patient to his or her baseline.
The Respiratory Team works closely with physical therapists, occupational
therapists, and speech therapists to coordinate weaning while allowing
time for the other therapies to increase strength and functionality.

Dietician

Patients with neurological diseases are at increased risk of micronutrient
deficiency and dehydration. On the other hand, nutritional factors may
be involved in the pathogenesis of neurological diseases. Dysphagia, ventilator
support, malnutrition, and modified diets are just a few examples of disease
processes monitored by the dietitian.

Our licensed Dietician conducts a nutritional assessment for each patient
once admitted and designs a nutritional menu plan with patient input.
Recommendations are provided and shared with clients and Treatment Team
members in order to promote healthy meal planning and nutritional meals.
Our dietician increases caloric support as we lessen ventilator support
in order to enhance the patient's ability to wean.

Physical Therapy Team

Physical Therapy is an integral part of our team approach in the “Journey
to Neuro Recovery” at Kentfield Hospital. We work closely with the
patient, family, and other Kentfield Hospital team members in the customized
treatment approach of patients. Our program is based on evidence-based
studies and experience that “Early Mobilization” of patients
improves outcomes.

Our physical therapists have experience working with all patients, from
a coma to those who are independent with limited functional mobility (moving
in and out of bed, transfers, walking). It is especially the ability of
our physical therapists to work with patients in coma, vegetative or minimally
alert states and patients that are not ready for acute rehab that sets
our program apart from other brain injury programs. Many brain injury
patients (traumatic brain injury, anoxic brain injury, and stroke patients)
or other neurologic patients are not ready to go to acute rehabilitation
or to skilled nursing after leaving the acute care hospitals. Our “Journey
to Neuro Recovery” program will work with these patients to help
prepare them to be ready for acute rehabilitation, subacute, skilled nursing,
or even possibly home.

Our customized physical therapy program involves but is not limited to:

Early mobilization (sitting edge of the bed, up in a wheelchair, standing
on tilt table or standing frame or other methods of standing) of all patients
that do not have medical contradictions in doing so. This often improves
patient alertness and the ability to wean the patient from ventilators
and decannulation of tracheostomies as part of our “Free to Breathe
Program”

Work on head control, sitting and standing balance and postural awareness
including vestibular rehab

Attempts at following commands (verbally, in context or with visual or
manual demonstration)

Work on patient’s ability to visually follow objects and become more
aware of their environment

Working closely with the physicians regarding medications that might be
preventing the patient from being alert or that might help patients become
more alert. Also giving physicians feedback regarding medications or behavioral
plans for patients that are motor restless or agitated

Team approach to treatment (working in collaboratively with patients, families,
other therapists, nurses, doctors and case managers)

Therapeutic exercise and neuromuscular re-education to maintain to increase
range of motion, to facilitate movement and to increase strength and endurance

Prone progression (getting patient on stomach on mat or over gymnastic
balls, on hands and knees and kneeling) if medically appropriate to increase
alertness, provide sensory stimulation and to provide different positions
to increase head control, range of motion, strength and balance

Provide education and training of the patient, family, friends and caregivers

Use of specialized equipment for treatment such as customized wheelchairs,
tilt table, standing frame and Lite Gait (a body weight supportive gait
training device so walking can begin before the ability to use parallel
bars or other walking devices such as canes and walkers)

The ability to have a restorative nursing aide to assist the physical therapists
to move and treat patients that require more than one person to physically
and safely treat

Prepare the patient for the next phase in their “Journey to Neuro
Recovery”

Occupational Therapy Team

Occupational Therapy is an integral part of the team in the “Journey
to Neuro Recovery” program at Kentfield Hospital. Occupational Therapists
focus on maximizing patient’s independence with activities of daily
living (including but not limited to eating, grooming/hygiene, upper body
& lower body dressing, toileting & bathing, toilet & tub/shower
transfers) and promoting functional use of patient’s upper extremities.

Patients receive a comprehensive occupational therapy evaluation and individualized
plan of care and treatment focusing on training patients to adapt to their
physical, cognitive and perceptual abilities. Through adaptation of techniques
and/or the environment and use of adaptive equipment, patients learn skills
to progress toward independence in daily living.

Occupational Therapists also work in collaboration with the physicians
and other team members in detecting signs of responsiveness with patients,
who are in a coma, vegetative state or minimally conscious state, assessing
patient’s abilities to localize, visually track, and follow commands.

Speech Therapy Team

Our experience with patients with brain trauma allows us to address each
patient as a person, aligning goals specific to their cognitive and communicative
impairments, as well as their personality, background, family needs, and
interests. We address aphasia (language impairment), cognition (memory,
safety judgment, and organization), dysarthria and apraxia (oral musculature
changes). Whether the patient is currently in a coma, is progressing through
the stages of coma recovery, or is recovering from other neurologic insults,
we tailor the therapy to the patient. This may include augmentative computer
communication, a Day Planner, structured therapy, and/or specific cueing
from the well-trained therapy team and nursing.

Speech Therapy also works closely with Respiratory Therapy to help wean
patients from vents and tracheostomies. As the patient progresses, we
carefully assess abilities to tolerate food and liquid, which may or may
not include an on-site Modified Barium Swallow Study (MBSS). All diagnostics
and therapy are tailored to the patient’s diagnosis, abilities,
needs, and progress rate with the goal of returning to full meals.

Case Management Team

The Case Management teams are critical members of the interdisciplinary
team as they are the link connecting the patient, the hospital care team,
and the insurance company. The Case Management department is comprised
of registered nurses and social workers who specialize in providing guidance,
support, and education to help navigate the complicated world of healthcare.

The Case Managers coordinate care needs both while in the hospital and
after discharge including appointments, home care needs, transportation
assistance, outpatient treatments, and transferring to alternative care
facilities. The Case Managers work with the families to identify lower
levels of care. The families are encouraged to visit these facilities
and organizations to identify the next step in the process of recovery.
In addition, the Case Managers educate and assist with access to insurance
benefits, authorization for inpatient and outpatient care needs, and apply
for alternative programs that can help patients obtain the resources they require.

Treatment Plan

Medical records from the prior hospitalization are reviewed by our staff
before and after the patient arrives. Our physicians and nurses speak
with the transferring hospital’s physician and nurse prior to the
patient’s arrival at Kentfield Hospital. A successful handoff allows
for our accepting staff to be best prepared for the care and continued
focus of the transferring treatment plan.

Over the first three days, the patient is assessed by the various members
of our team. The attending physician works with the team to plan the various
steps leading to the care and treatment of the patient over the course
of the inpatient stay. The plan is updated regularly as required for the
patient’s needs. The attending physician meets with the clinical
team weekly. They review the patient’s past week’s successes
and opportunities and prioritize the next steps of the patient’s
road to recovery.

Transitions to Next Steps of Recovery

Upon arriving in our hospital, the Case Management team will schedule a
Care Conference with the patient, the support system, and member of the
interdisciplinary team in order to discuss what the patient’s care
goals are. A care plan will be created in order to clarify what recovery
goals are anticipated during the hospitalization, and what next steps
to expect.

Once our inpatient care goals are reached, there are various different
options for continued recovery such as Acute Rehabilitation Centers, Skilled
Nursing Centers including Subacute Facilities, Congregate Living Facilities,
Outpatient Care Centers, and Home Care within the home environment. The
Case Management team will help make the transition out of our hospital
as smooth as possible with careful discharge planning and care coordination.

Outpatient Services

As patients transition to our Outpatient Program, they are met with a comprehensive
team of Physical Therapist, Occupational Therapist and Speech Pathologist
to continue their recovery. We are proud to provide an hour long one on
one session to focus and attend to a variety of details and work towards
the continuation of recovery to higher levels of independence. The team
approach from each discipline develops a plan of care towards the individual
and family goals collaborated with the therapist.

The therapy team has extensive backgrounds for neurological care, orthopedic
care, vestibular, balance and gait, lymphatic, and cardio pulmonary. Splinting
and custom orthosis can be constructed by our Certified Hand therapists
with adaptions to assistive devices and recommendations for equipment
for independence. Our highly regarded wound team is also available for
any care that may be required as clients continue their recovery to their
highest level.

Patient Admissions

Referral Process

The referrals from Kentfield Hospital come from a variety of sources. Most
referrals come directly from the hospitals where the patient is located
through the physicians and case managers. The referrals can also come
from family members, workers compensation adjusters, health plans and
others in the community. Each referral is reviewed for clinical necessity
and clinical treatment viability. Next, those referrals that clinically
require Kentfield Hospital’s services are processed administratively.
This administrative process can include review by the CEO, review by a
physician and review with the payer source. After the patient’s
information is reviewed and the patient is accepted by the CEO, the patient
is invited to Kentfield Hospital after being medically cleared by the
sending physician.

Admissions Process

Admitting staff receives prior notice of the date and time of a patient’s
arrival. Upon admission, the patient or their designee must sign the Conditions
of Admissions form to enable Kentfield to begin treatment. If the patient
is unable to sign for him/herself, please have someone accompany the patient
to the hospital. If a designated person cannot be present at the time
of admission, please make arrangements to complete the admission paperwork
prior to the patient’s arrival.

Kentfield also requires a copy of the insurance cards, identification card
or drivers license, a copy of the patient’s advance directive/durable
power of attorney and additional information as requested. Next, the patient
and family will be met by a member of the nursing staff who will answer
questions about the patient’s care or accommodations.

Settling into Kentfield

The first 2-3 days of a patient’s admission to Kentfield Hospital
is an opportunity for the patient to learn the hospital staff and the
staff to learn the needs, wants and desires of the patient and their family.
The staff will be conducting studies of the patient and their care needs.
Some of these tests may be duplication of tests from the previous hospitalization.

Depending upon the patient’s clinical needs, the patient will be
encouraged to wear their own clothes. The clothes should not be constricting,
especially for those on a ventilator or who have received a tracheostomy.
Also, there may be an opportunity for the patient to go outside onto the
patio. For many patients, this is the first time they have enjoyed being
outside the hospital in weeks.

<The following section was added to the Kentfield Hospital site as a
list link>

ITEMS PATIENTS ARE ENCOURAGED TO BRING

5-6 outfits of loose-fitting tops & pants

Undergarments

Sweater or jacket

Supportive pair of athletic shoes with non-skid soles

Pajamas

Gown/Robe

Soap (if you prefer a certain brand)

Toothbrush

Toothpaste

Mouthwash

Dentures

Comb or brush

Shaving cream

Razor

Cosmetics

Deodorant

Lotion

Perfume/Aftershave

Insurance cards

Medical information

Eyeglasses and/or contacts

Hearing aids

Incontinence pads (if needed)

Pillow

Blanket

Family pictures

Laundry basket/bag

PLEASE DO NOT BRING VALUABLE ITEMS THAT MAY BE DAMAGED OR LOST

Education and Resources

Education

In-patient education is provided to patient/caregivers by a trained Neuro-Nurse
and/or Nurse Educator. An individualized education plan is assessed based
on patient’s neurological injury. Nursing education is implemented
based on improved understanding of medical condition, disability related
to the brain injury. Evaluations of learning needs are performed at the
bedside, with return demonstration of understanding verbally or thru observation.

Bedside education and return demonstration of understanding by the patient/caregiver(s)
is provided to the Team members weekly with the interdisciplinary team
(IDT) meetings and weekly rounds with the Physicians

Resources

Your are encouraged to learn more about brain injuries and the healing
pathways that can occur.

Kentfield Hospital Foundation is a non-profit organization 501(c)(3) founded
in 1983 and dedicated to providing assistance, support and encouragement
to patients and families. The Foundation serves the needs of patients
that fall outside the scope of hospital services, insurance or other funding services.

These needs may include:

equipment not covered by insurance for patients during their hospital stay

personal items for the comfort of patients during their hospital stay

assistance for immediate family from outside the area

recreation and entertainment to lift the spirits of patients and their families

staff appreciation for their care and dedication to the patients’
well being